目的：系统评价不同给药途径应用血小板糖蛋白（GP）IIb/IIIa受体拮抗剂在急性ST段抬高型心肌梗死(STEMI)患者急性介入治疗中疗效与安全性的比较。 方法：计算机检索PubMed、Embase、Cochrane图书馆、CNKI、VIPH和万方数据库，检索时间截止2014-03。纳入有关GP IIb/IIIa受体拮抗剂先冠状动脉（冠脉）后静脉给药组（冠脉联合静脉给药组）与单一静脉GP IIb/IIIa受体拮抗剂给药组（单一静脉给药组）的随机对照试验，由2名研究者对纳入文献进行评价和资料提取，根据Cochrane Handbook 5.0.2质量评价标准评价纳入研究质量。采用RevMan 5.0软件对数据进行合并。 结果：最终纳入20个随机对照试验（共包括2494例患者，包括冠脉联合静脉给药组1258例，单一静脉给药组1236例）。冠脉联合静脉给药组在经皮冠脉介入治疗（PCI）术后心肌梗死溶栓治疗临床试验3级血流、PCI术后心肌灌注分级3级、术后ST段完全回落、术后1个月主要心脏不良事件、梗死面积变化（P均<0.01）、术后1个月心绞痛发生、PCI术后1个月患者死亡、术后再次靶血管重建（P均<0.05）均优于单一静脉给药组，差异均有统计学意义。其中上述前5个指标有显著统计学差异（P<0.01）；而两组在术后1周左心室射血分数、PCI术后1个月再次心肌梗死发生情况、术后出血、用药后血小板减少相似，差异无统计学意义（P>0.05）。 结论：冠脉联合静脉应用GP IIb/IIIa受体拮抗剂可提高在STEMI患者中的应用疗效，而并不提高术后出血、术后血小板减少的不良反应，故可作为一种有效安全的给药方式用于STEMI患者。%Objective: To compare the safety and efifcacy of platelet glycoprotein IIb/IIIa antagonist in treating STEMI patients by intracoronary-intravenous administration and intravenous administration. Methods: We searched PubMed, Embase, Cochrane library, CNKI, VIPH and Wanfang database, the retrieval stopped at 2014-03. According to 5.0.2 Cochrane handbook, 2 scientists collected 2494 STEMI patients treated by IIb/IIIa antagonist from 20 references, and they were divided into 2 groups. Combination group, the patients received intracoronary, then intravenous administration, n=1258 and Intravenous group, the patients receive only intravenous administration, n=1236. RevMan 5.0 software was used for Meta-analysis. Results: At 1 month after PCI treatment, compared with Intravenous group, the Combination group had better conditions of TIMI 3, TMP 3, ST segment recovery, MACE occurrence and MI area changes, all P<0.01; Combination group also showed better conditions of angina recurrence, death and post-operative target vessel revascularization, all P<0.05. LVEF was similar between 2 groups at 1 week after PCI. MI recurrence, post-operative bleeding and thrombocytopenia were similar between 2 groups at 1 month after PCI, all P>0.05. Conclusion: Intracoronary-intravenous administration of platelet glycoprotein IIb/IIIa antagonist had the better effect for treating STEMI patients without increasing the side effects of post-operative bleeding and thrombocytopenia.
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